Treatment of psoriasis/psoriatic arthritis has historically followed a stepwise approach. Patients are initiated on the first step with topical therapies and only progress to the more aggressive therapies if they are unsuccessful with the previous therapy.


Step 1 - Topical therapy
Step 2 - Phototherapy Step 3 - Systemic therapy

Over-the-counter products
- Emollients
- Other

Topical retinoids
Topical steroids
Vitamin D analogs


Broadband UVB
Laser
Narrowband UVB
PUVA

Acitretin
Cyclosporin A
Methotrexate
Systemic steroids


At the systemic therapy step, due to the limitations of these agents, they are rotated to avoid cumulative toxicity. This approach is not appropriate for all patients as it often involves regimens that are inconvenient. In addition, regular monitoring for serious side effects is required.



Continuous control is difficult to achieve and many patients become stuck in a cycle of successful therapy followed by relapse. New approaches to the treatment of psoriasis/psoriatic arthritis may allow physicians to offer their patients long-term control with greater confidence: the development of the new biological therapies is changing the way psoriasis and psoriatic arthritis are managed.



Optimism has been brought to both psoriasis and psoriatic arthritis treatments through the development of new therapeutic options. The efficacy, safety, convenience and improvements in quality of life achieved with these new biological therapies are raising hopes that continuous control can be achieved, the vicious circle can be broken, and a new treatment paradigm can begin.


New therapeutic options:
Amevive (alefacept)
Enbrel (etanercept)
Humira (adalimumab)
Raptiva (efalizumab)
Remicade (infliximab)



At an international conference in 2004, a consensus statement was developed to establish how new therapeutics should be incorporated into the armamentarium for the treatment of psoriasis/psoriatic arthritis1.. Views from various countries around the world including USA, Switzerland, and European and Latin American countries were aired. The limitations of current therapies were highlighted and the value of biological therapies for psoriasis/psoriatic arthritis was discussed. It was agreed that biologicals should be given equal consideration among primary agents that are appropriate for patients who are candidates for systemic therapy and guidance was developed regarding the incorporation of biological therapies into clinical practice.



There are many different therapies and treatment regimens and it is important that you discuss these with your dermatologist in order to find the best option for you. Your local patient association will also be able to provide you with a wealth of information, support and guidance to help you.

You may find it useful to read stories about other people who have had psoriasis and the journeys that they have followed. The following are examples showing how different treatments work for different people.

>> Beckie




For more information, please contact the WPD secretariat:

WPD Secretariat
9 Princeton Mews
167-169 London Road
Kingston-upon-Thames
Surrey KT2 6PT
UK
Tel: +44 (0)20 8288 7840
Fax: +44 (0)20 8288 7844
Email: getintouch@worldpsoriasisday.com
www.worldpsoriasisday.com


1. Sterry W, Barker J, Boehncke WH, Bos JD, Chimenti S, Christophers E, et al. Biological therapies in the systemic management of psoriasis: International Consensus Conference. Br J Dermatol. 2004;151 Suppl 69:3-17.